Health
6:20 pm
Wed May 14, 2014

Insurance Department Holds Hearing On Narrow Network

Politicians in New Hampshire have done plenty of arguing over the Affordable Care Act. Today, lawyers were given a turn.

A long-awaited hearing was held at the state Insurance Department. At issue is a complaint filed by an East Rochester woman over alleged harm suffered at the hands of Anthem’s limited network of hospitals.

Margaret McCarthy was a bookkeeper and office manager, but now, in her early 60s, she’s content volunteering as treasurer of her church.

Margaret McCarthy testifying Wednesday in Concord.
Margaret McCarthy testifying Wednesday in Concord.
Credit Todd Bookman / NHPR

Without full-time employment, she’s been buying an insurance policy through Anthem that until recently, she was happy with. That is, until she learned that the state’s largest insurer was limiting the number of hospitals for its new plans sold through the Affordable Care Act.

“I do not want to give up my doctor. And that’s plural: doctors. Every doctor I see is affiliated with Frisbie,” says McCarthy.

The Rochester-facility is one of 10 New Hampshire hospitals excluded from the network for plans sold under Obamacare; a move Anthem says reduces the price tag for these policies by 25%.

McCarthy says if she buys a different plan that includes her doctors, she’s out nearly $3,000 dollars because she wouldn’t be able to access subsidies through healthcare.gov.

So along with Frisbie, McCarthy filed a complaint with the Insurance Department. She says she is happy to be the face of this fight.

“Absolutely, I feel like I was the voice for all the people that sort of got left out of this network,” says McCarthy.

ISSUE TURNS TECHNICAL

During five-and-a-half hours of testimony Wednesday, lawyers for both the Insurance Department and Anthem presented evidence they say proves the narrow network doesn’t violate any laws.

One factor that regulators consider before approving plans is if patients are within a reasonable distance to in-network doctors and hospitals.

An example: no more than 15 miles to a primary care practice.

Richard McCaffrey, a lawyer for the Insurance Department, uses thumb tacks to mark providers in Strafford County.
Richard McCaffrey, a lawyer for the Insurance Department, uses thumb tacks to mark providers in Strafford County.
Credit Todd Bookman / NHPR

Richard McCaffrey, a lawyer for the Insurance Department, used thumb tacks on an oversized map of Strafford County to show McCarthy that she wouldn’t have to travel all that far to the next nearest hospital.

“Your house as the crow flies is 11 miles from Wentworth Douglas?” McCaffrey asked.

“That’s about right, yup,” responded McCarthy. “Hard to travel in a car that way, though.”

DEPARTMENT SAYS ITS HANDS ARE TIED

There’s also the question of if the Department has the legal ability to tell Anthem who to make its deals with.

With Deputy Commissioner Alex Feldvebel on the stand, Attorney McCaffrey asked, “Does either of our network adequacy laws allow the Insurance Department to dictate to an insurance company, say Anthem, that it must contract with any particular hospitals, providers or other medical providers or services?”

“No, we don’t have that authority,” Feldvebel responded.

Lawyers for McCarthy question that lack of authority. They say if there’s been a wrong committed here, the Department does have the power to make it right.

Insurance Department Commissioner Roger Sevigny will get the final say on the issue. He’s giving both sides two more weeks to submit any final paperwork before he issues a ruling.

Frisbie President Al Felgar says regardless of the outcome, he’s happy the issue is finally getting its day.

“Well, let’s see what the Commissioner says. Maybe there is some compromise here? You know, compromise is part of life,” says Felgar.

The whole issue may resolve itself in 2015, when more insurance companies will likely begin selling plans through the exchange that have a much broader network of hospitals.